ENTREPRENEURSHIP DEVELOPMENT INSTITUTE OF INDIA
DIPLOMA IN ENTREPRENEURSHIP & BUSINESS MANAGEMENT
APPLICATION FORM
Application for the batch:
(Tick in the appro.box)
January
April
July
October
1.0
Name : Mr./Mrs./Ms/
Address for communication:
Pin:
Tel. No. (with S T D code):
E – mail:
1.1
Mobile No :
Permanent Address:
Pin:
Tel. No. (with S T D code):
E – mail:
1.2
Emergency Contact No:
1.3
Blood Group:
2.0
Date of Birth: Date
2.1
Place of Birth:
2.1
Age:
3.0
Religion: Hindu / Muslim / Christian / Sikh / Jain / Others
3.1
Caste :
Month
3.2
Sub Caste:
Year
3.3
Category : General / SC / ST/ OBC/Others(Specify)
3.4
Academic Category : Science / Commerce / Arts / Others
3.5
Gender: Male / Female
3.6
Territory: Rural / Urban / Tribal
3.7
Disability (please Specify, if any):
3.8
Marital Status:
3.9
Nationality:
4.0
Medium:
5.0
Educational Qualification:
English
Gujarati
Stream
Year
University/Board
Post Graduate
Graduate
Diploma
Non-graduate
6.0
Work Experience:
Name of Organisation
7.0
Nature of work
Present Occupation : ( tick in the appropriate box)
Study
Service
Business
Housewife
Others
Duration (yrs.)
8.0
Family Background : ( tick in the appropriate box)
Service
Business
Others
No formal
Involvement in income generating activity
9.0
How did you come to know about this course?
Newspaper
Personal contact
Counsellor/nodal agency
Others
10.0
Which city would you prefer for counseling services? Give three choices.
11.0
1.
2.
3.
Details of fee:
Cash / Demand draft
Demand draft no.
Name of Bank and date
For Rs.*
Date:
Place:
Signature:
Please send duly filled-in application form, with two stamp size photographs, proof of
educational qualification and Course fee Rs.12,500/-.
OPEN LEARNING DIVISION
ENTREPRENEURSHIP DEVELOPMENT INSTITUTE OF INDIA
VIA INDIRA BRIDGE, P.O. BHAT – 382 428, DIST GANDHINAGAR,
GUJARAT
TEL : 079-23969161/62, 23969163
E-MAIL: olpe@ediindia.org
FAX : 079-23969164